TY - JOUR
T1 - The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction
AU - Chiang, Hsu Po
AU - Aguiar, Miguel O.D.
AU - Tavares, Bruno G.
AU - Rosa, Vitor E.E.
AU - Gomes, Sergio Barros
AU - Oliveira, Mucio T.
AU - Soeiro, Alexandre
AU - Nicolau, Jose C.
AU - Ribeiro, Henrique B.
AU - Sbano, João C.
AU - Rochitte, Carlos E.
AU - Filho, Roberto Kalil
AU - Ramires, Jose A.F.
AU - Porter, Thomas R.
AU - Mathias, Wilson
AU - Tsutsui, Jeane M.
N1 - Publisher Copyright:
© 2022 American Society of Echocardiography
PY - 2023/5
Y1 - 2023/5
N2 - Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. Methods: One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography–derived global longitudinal strain (GLS). Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.
AB - Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. Methods: One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography–derived global longitudinal strain (GLS). Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.
KW - Acute myocardial infarction
KW - Left atrial remodeling
KW - Left atrial strain
KW - Left ventricular diastolic dysfunction
KW - Sonothrombolysis
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U2 - 10.1016/j.echo.2022.12.010
DO - 10.1016/j.echo.2022.12.010
M3 - Article
C2 - 36535625
AN - SCOPUS:85146124587
SN - 0894-7317
VL - 36
SP - 504
EP - 513
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 5
ER -